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09.36 AP.211
Hebron Band and Choir all Trip Permission Slip
Not to leave or separate from the group without appropriate authorization from a
teacher/chaperone.
Comply with all school and District policies and rules of conduct.
In the event any of the above expectations or instructions are violated, I understand school officials reserve
the right to remove the student from the trip and the student will be subject to disciplinary consequences.
I UNDERSTAND THAT PARTICIPATION IN FIELD TRIPS MAY INCLUDE ACTIVITIES THAT
INVOLVE RISK OF HARM TO MY CHILD. I ACKNOWLEDGE I AM FULLY INFORMED OF THE
ACTIVITIES CONTEMPLATED.
I hereby give permission for my child to participate in the above-mentioned school-related student
trip(s). During an emergency, I authorize any and all physicians, trained school personnel, and/or
other medical providers to render such emergency treatment as deemed necessary for the health of my
child. Furthermore, I acknowledge that I am responsible for any and all medical expenses, to include
transportation to a medical facility, incurred as a result of my childs participation in this school field
trip. If any emergency medical procedures or treatments are required during this trip, I consent for
the trip supervisor/sponsor(s) to arrange for them at their discretion.
________________________________________________________
Parent/Guardians Signature
Phone Number
__________________
Date
Review/Revised:6/24/13
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